A comparison of maternal and neonatal outcomes with forceps delivery versus cesarean delivery

Abstract

Objective: To compare maternal and neonatal outcomes by forceps vaginal delivery versus cesarean delivery during the second stage of labor.

Methods: We conducted a retrospective cohort study in a large tertiary maternity center in Shanghai, China through 2007–2016. A total of 7046 women carrying a singleton term nonanomalous fetus with vertex presentation who underwent forceps vaginal delivery, or cesarean delivery from a low station in the second stage of labor were included.

Results: Of the 7046 women, 6265 underwent forceps and 781 underwent second stage cesarean delivery. Forceps were associated with lower frequency of maternal infection (2.2 versus 4.7%), but higher incidence of mild postpartum hemorrhage (PPH) (4.3 versus 0.6%). When the procedures were performed for fetal indication, forceps were associated with lower frequency of the composite of perinatal mortality and/or hypoxic ischemic encephalopathy (HIE) (0.5 versus 1.9%; adjusted odds ratio (aOR), 0.24; 95% CI: 0.08–0.75), and also shorter decision to delivery interval (12.3 ± 3.5 versus 19.1 ± 5.0 min). The neonatal infection rate was higher in the forceps group (3.9 versus 2.0%). There were no differences in other neonatal outcomes including birth trauma.

Conclusions: In women who had a need for intervention during the second stage with a station of +2 or below, forceps were associated with a lower frequency of maternal infection but a higher rate of PPH. Deliveries performed for nonreassuring status were accomplished faster by forceps and were associated with a lower frequency of the composite of perinatal mortality and HIE.

Keywords:

• Attempted forceps delivery
• cesarean delivery
• hypoxic ischemic encephalopathy
• perinatal mortality

Acknowledgments

The authors thank Cheng Lei, the information engineer of IPMCHH for his support of the data collection, every midwife in the LDR for the detailed delivery records.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Sponsored by the Interdisciplinary Program of Shanghai JiaoTong University [Project number: YG2016MS41].